Psychologist David Curtis says the checklist touches on a child's experiences outside of the examination room.

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Pediatric symptom checklist

Here are some examples of the 17 questions Texas Children's Hospital will use to identify mental-health issues in their young patients. Parents are asked to circle "never," "sometimes" or "often" to these symptoms:

5-9: the percent of youths with severe emotional disturbance and extreme impairments

In a routine physical exam, it's possible for a pediatrician to miss signs of a child's emotional problems.

But a basic 17-item checklist will soon make it possible for pediatricians to screen their patients for mental-health issues in just a few minutes. The checklist is simple, allowing parents to evaluate certain statements - basic ideas such as "feels hopeless," "worries a lot" or "does not listen to rules" - and circle "never," "sometimes" or "often." In some children, a pattern will be obvious.

It's a window into the children's lives that the doctors haven't had until now.

"Kids experience things that you don't see in the examination room," says David Curtis, a psychologist and program coordinator for the primary care psychology program at Texas Children's Hospital.

The goal was to find a fairly brief, easy-to-use and accurate way to uncover emotional or behavioral problems. In an ordinary examination, the doctor might feel too rushed to ask the questions that would disclose a problem, but this assessment can even be filled out with the help of a medical assistant before the doctor goes into the examination room.

The system, developed at Texas Children's, will eventually be used at all 48 of the hospital's clinics, its 10 health centers and two hospitals. It screens for attention issues, externalizing symptoms (such as fighting) and internalizing symptoms (such as depression). A similar screening already is in use to detect signs of autism.

In addition, the checklist asks one more question: "Does your child have any emotional or behavioral problems for which she/he needs help?" If the answer to that one is yes, the doctors will do a follow-up no matter what the other score is, says Curtis.

The checklist can be used for children and adolescents 4 to 18 years old, and the hospital's goal is to assess every child at ages 7 and 11. Some 20 percent of young people have a diagnosable disorder at some point.

The Pediatric Symptom Checklist was the idea of Michael Jellinek, professor of psychiatry and pediatrics at Harvard Medical School, and psychologist Michael Murphy, some 30 years ago. After 10 years of testing, they came up with the original 35-question version of the checklist. (If you want to see it, go to massgeneral.org.)

"We could screen for vision, hearing, height, weight, but we had no way to screen for mental health issues," says Jellinek.

The idea was to develop a tool that parents could easily use to identify the emotional health of a child. A simplified 17-question version came later, though Jellinek still prefers the longer one.

The checklist caught on. It is now required for all children in Massachusetts and for all children entering school in Chile. In fact, the test is available in 20 languages. Jellinek can't say exactly how popular it is because there's no national registry, and they know of the popularity only through phone calls.

For the past 20 years, they have been looking at the statistics for immigrant populations, rich vs. poor and a host of other groups.

Jellinek stresses that a child who scores an "often" on, say, one question is certainly not at risk.

Over the years, he says, pediatric care has moved away from treating infectious disease to treating the whole child.

He also stresses that the test is not diagnostic. If a child shows evidence of a problem based on the checklist, parents or caregivers will be given information about different diagnoses and then will be asked to come back in 30 days for follow up.

"We've created a whole host of resources," says Curtis. "They can leave with a stack of resources."

If, after the 30 days, they find there are more significant concerns, the physicians can then make a specialty referral or treat the patient on site.

Curtis, along with Alison Shellman, who holds a master's in education, worked with pediatricians to find out what would be most useful for their practices, developed the resources the doctors could give their patients and educated pediatricians on the program. Right now, the assessment is being used in a pilot program at Pediatric Medical Group on Kirby. Shellman has worked closely with the medical assistants there to make sure they know how to use and score the checklist.

"It's very challenging," Curtis says. "Physicians crave the ability to help patients more comprehensively."